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Genetic Contribution in Low Back Pain: A Prospective Genetic Association Study
Author(s) -
Margarit César,
Roca Reyes,
Inda MaríadelMar,
Muriel Javier,
Ballester Pura,
Moreu Rocío,
Conte Anna Lucia,
Nuñez Angela,
Morales Domingo,
Peiró Ana M
Publication year - 2019
Publication title -
pain practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 58
eISSN - 1533-2500
pISSN - 1530-7085
DOI - 10.1111/papr.12816
Subject(s) - medicine , neuropathic pain , rs4680 , opioid , chronic pain , analgesic , anesthesia , pharmacogenetics , catechol o methyl transferase , physical therapy , genotype , genetics , receptor , biology , gene
Objectives Chronic pain is one of the most common reasons individuals seek medical attention. It is a major issue because of the wide interindividual variability in the analgesic response. This might be partly explained by the presence of variants in genes encoding molecules involved in pharmacodynamics and pharmacokinetics. The aim was to analyze opioid effectiveness in chronic low back pain ( CLBP ) relief after opioid titration, unveiling the impact of pharmacogenetics. Methods The study included 231 opioid‐naïve patients from the Spine Unit; age 63 ± 14 years, 64% female, body mass index 29 ± 6 kg/m 2 , visual analog scale pain intensity score 73 ± 16 mm. Clinical data were collected at baseline, 3 months after opioid titration, and after 2 to 4 years of follow‐up concerning pain (intensity and relief), quality of life, disability, comorbidities, and drug prescription (opioid dose, rotations, and adverse events). The genotype influence of OPRM 1 , COMT , UGT 2B7 , ABCB 1 , KCNJ 6 , and CYP 3A5*3A in analgesic response was analyzed by reverse‐transcription polymerase chain reaction genotyping. Results Patients with the COMT G472A‐ AA genotype (rs4680) and KCNJ 6 A1032G‐A allele (rs2070995) CLBP responded differently to opioid titration, with higher pain intensity requiring higher dosing. Furthermore, GG ‐ genotypes of A118G ( OPRM 1 , rs1799971) and A854G ( UGT 2B7 , rs776746) influenced the neuropathic component. After opioid titration, CLBP intensity, neuropathic component, low back pain disability, anxiety, and depression significantly decreased, while quality of life improved. Conclusion Single‐nucleotide polymorphisms in genes involved in pain transmission and opioid metabolism might predispose to exaggerated sensitivity and differences in the opioid analgesic effect in patients with CLBP . We encourage clinical trials for their clinical application in chronic pain management.